Provider Demographics
NPI:1245305838
Name:SEAN LESON DO MPH PC
Entity type:Organization
Organization Name:SEAN LESON DO MPH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LESON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-590-1611
Mailing Address - Street 1:12512 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1907
Mailing Address - Country:US
Mailing Address - Phone:714-590-1611
Mailing Address - Fax:714-590-1641
Practice Address - Street 1:12512 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1907
Practice Address - Country:US
Practice Address - Phone:714-590-1611
Practice Address - Fax:714-590-1641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6461261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF67337Medicare UPIN
CAF67337Medicare UPIN
CA00AX64610Medicaid